Network Support Manager

Job Description

Job Description

Job Title: Network Support Manager

Location: Tuscon, AZ , Green Valley, AZ

Anticipated Start Date: ASAP

(Please note this is the target date and is subject to change. BCforward will send the official notice ahead of the confirmed start date.)

Job Type: Full time

Pay Rate: $90K

(Please note that actual compensation may vary within this range due to factors such as location, experience, and job responsibilities, and does not encompass additional non-standard compensation (e.g., benefits, paid time off, per diem, etc.).

About BCforward

BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.

Job Description:

The Network Support Manager ensures that provider network is optimized for access, quality, compliance, and performance. This role is accountable for operational execution, network issue resolution, provider engagement, and alignment to value-based performance goals.

Coordinates workflow and tactical implementation of various activities related to maintaining facility, provider network and contracting initiatives. Participates in projects designed to improve all levels of network performance, which may include multiple lines of business.

Technical Competencies

Familiarity with Medicare Advantage, Medicaid Managed Care, and value-based care models.

Understanding of CMS/state quality programs, risk adjustment, and utilization management.

Competency in claims analysis, provider performance dashboards, and EHR/workflow navigation.

Experience with provider contracting language and operational requirements.

Primary duties may include, but are not limited to:

May oversee the day-to-day training, guidance and management of department activities and facilitates resolution of problems and issues.

Analyzes and coordinates strategies, policies and programs to ensure accurate administration of facility provider contracts across multiple lines of business and multiple platforms.

Creates tools to assist contract implementation and administration.

Interfaces with providers on contractual obligations, education, and provider operations manual updates.

Coordinates and acts as a business partner on projects that ensures accurate facility and provider reimbursement policy and procedures, such as pricing, POC, OHAS HMO AND OHAS II, complaints and appeals etc.

Education / Experience

Requires a BA/BS degree and a minimum of 3 years' experience in the health care industry with background in provider relations, facility contracting and reimbursement, or any combination of education and experience, which would provide an equivalent background. MBA, MHA, or related graduate degree strongly preferred.